Case Study 2: Explosive foot injury and sudden bills

The youngest Le Roux family member suffered an explosive foot injury which required emergency attention. Not understanding medical billing terminology and suddenly finding themselves responsible for fighting with the medical aid for shortfalls from service providers, the Le Roux’s could luckily call on Practice Plus for assistance, who were billing on behalf of their surgeon.
Case Study 2

The youngest Le Roux family member suffered an explosive foot injury which required emergency attention. Not understanding medical billing terminology and suddenly finding themselves responsible for fighting with the medical aid for shortfalls from service providers, the Le Roux’s could luckily call on Practice Plus for assistance, who were billing on behalf of their surgeon.

Case study 2

The Story

One Saturday afternoon young Sarah Le Roux experienced a traumatic foot injury which required the emergency attention of both surgeon and anaesthetist. With surgery being a success, the family were assured the surgery was a PMB* case, which meant they could leave the hospital knowing their Medical Aid would cover the cost.  The Le Roux’s were clearly astonished by the bills they were receiving that were only partially paid.  

Unfortunately, the anaesthetist submitted incorrect coding to the Medical Aid, which was when Le Roux’s received their first bill. Not understanding the medical billing jargon and why they needed to pay, they turned to Practice Plus for assistance.

Practice Plus saves money

Practice Plus instantly contacted the doctor’s rooms to get a letter of motivation. Next, contact was made with the Anaesthetist to advise incorrect ICD 10** codes had been used for the surgery. The Anaesthetist recognised the mistake immediately and reprocessed the account; allowing for the Le Roux’s Medical Aid to oblige full payment to all service providers.

Had Lisa not assisted me in understanding the relation between ICD coding and PMBs I would have either been out of pocket by a substantial amount of money or stuck in the middle of a battle between the medical aid, service providers and gap cover.  I cannot recommend the service given by Practice Plus highly enough and am most grateful for the initiative taken by them in guiding a non-medical person through the process.” Mrs M Le Roux

Descriptions:

*PMB – Prescribed Minimum Benefit

**ICD 10 Code – International classification of diseases and related health problems. It is a coding system developed by the World Health Organisation (WHO), to translate the written description of medical and health particulars into standard codes.

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